Health care ruling frees state on TennCare spending mandate

Health care ruling frees state on TennCare spending mandate

NASHVILLE -- Gov. Bill Haslam said he is weighing Tennessee's options after the U.S. Supreme Court did away Thursday with a directive in the federal health law requiring states to participate in a massive expansion of their Medicaid coverage.

Justices upheld the constitutionality of most provisions in the federal Affordable Health Care Act, including the controversial individual mandate.

But they undid the law's mandate that states like Tennessee and Georgia join in a broadening of the state and federally funded Medicaid program for the poor. The program is called TennCare in Tennessee.

"What was unanticipated is the section of the opinion that says states cannot be forced to expand their Medicaid program," said Haslam, who opposed the federal law in its entirety. "This particular portion of the ruling is significant, but it is premature to know the exact ramifications."

Haslam, a Republican, and his Democratic predecessor Phil Bredesen were among many governors who complained about the expansion.

Already 1.2 million people, or about 20 percent of Tennessee residents, are on TennCare. The state projected 200,000 to 300,000 more people would join at a cost of $300 million or more. Bredesen once called it the "mother of all unfunded mandates."

State Finance Commissioner Mark Emkes said although officials are just beginning to sort through the implications, "we do feel a little bit better about the fact we're going to have more control over the Medicaid piece."

State Rep. JoAnne Favors, D-Chattanooga, hailed the court's ruling upholding most of the law.

"I'm just elated over this because we here in Tennessee have such a high, vulnerable population of citizens who do have health issues," said Favors, a retired health facility administrator and registered nurse.

With so many Tennesseans currently uninsured, Favors said, the law will benefit hundreds of thousands in a state whose residents have some of the nation's poorest rankings in areas like obesity and diabetes.

As for the Supreme Court giving Tennessee and other states freedom in deciding whether to extend Medicaid coverage to more people, Favors said, "I do think that we should carefully go ahead with expansion."

There's no question that states now have latitude in how to proceed, said James Blumstein, a constitutional and health expert who is a law professor at Vanderbilt University.

"The court held unconstitutional the [law's] mandated Medicaid expansion as linked to the preexisting Medicaid programs," said Blumstein, who opposed the mandate in a legal brief he filed with the Supreme Court. "But the court also held, as a remedy, that the expanded Medicaid program could proceed as long as states could decide whether to participate without having to put their existing Medicaid program at risk."